1184954307 NPI number — HOME CARE SERVICES OF IDAHO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184954307 NPI number — HOME CARE SERVICES OF IDAHO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME CARE SERVICES OF IDAHO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALTERNATIVE NURSING SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184954307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1827 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83501-3891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-746-3050
Provider Business Mailing Address Fax Number:
208-746-3640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6003 OVERLAND RD
Provider Second Line Business Practice Location Address:
SUITE L102
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83709-3073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-570-2928
Provider Business Practice Location Address Fax Number:
208-746-3640
Provider Enumeration Date:
01/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BEIER
Authorized Official First Name:
BRANDEN
Authorized Official Middle Name:
RAFAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-570-2928

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  121212 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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